Saint Francis announces health insurance plans

Employers throughout Southeast Missouri will have another alternative to consider this fall when they review employee health insurance options for 2021 — Saint Francis Health Plans.

Officials from Saint Francis Healthcare System met with media representatives Monday to announce the new direct contracting health insurance option, which, they said, will help employers manage their health insurance costs while helping improve the overall health of their workforce.

“The market has been asking for us to come up with something,” said Maryann Reese, president and chief executive officer of Saint Francis Healthcare System. “We think we have a great product and we think we are meeting the needs of our community by presenting this.”

Similar to traditional health insurance programs offered by many employers, Saint Francis Health Plans will provide a multitiered approach to primary and specialty care coverage. But unlike many other plans, the Saint Francis plans will offer a “tier one” option to use providers outside the Saint Francis network as if they were in-network providers.

“We’re not steering patients just to us, which is really, I think, what employers want and what employees want,” Reese said.

“With a wide-area network, what we have sought to accomplish is that, essentially, any provider, physician, facility within our market, in our local area of Southeast Missouri, will be included,” said Alex Ogburn, vice president of Saint Francis Medical Partners.

“There’s no punitive pricing and no punitive tiers that are going to be disruptive to the patient,” he said. “What that does, we think, is keep care local, and that’s better for our communities.”

According to a plan description provided by Saint Francis, if care is needed outside the Saint Francis network, “comprehensive benefits” will still apply and emergency care will always be provided at the “tier one” benefit level regardless of where care is provided.

In addition to traditional health insurance benefits, Ogburn said the new health plans will offer care management, with an emphasis on preventive care, designed to improve patient outcomes and overall health.

“Our approach is designed to lower member and employer costs, improve member benefits and establish long-term partnerships with care providers,” he said.

Initially, Saint Francis plans to promote the plan to companies with at least five employees throughout a 12-county area of Southeast Missouri, from Ste. Genevieve County to the north and extending through most of the Bootheel.

“That’s the core area where the greatest footprint for Saint Francis resources is located and that’s where we want to really focus on employers,” Ogburn said, adding the Saint Francis plans have been “structured in such a way as to be nimble and to be flexible” to meet the needs of employers and employees.

Saint Francis announced the program to health insurance brokers in the region in a conference call last week.

“We had more than 60 different broker groups represented (on the call), and in the course of the next 24 hours, we had over 750 hits to Saint Francis Health Plans dot com, our informational portal,” Ogburn reported, and said “a number of quote” are being developed as a result of that conference call.

A provider contract between Saint Francis and United Healthcare, which provides health insurance coverage for several large employee groups in the region, expired earlier this year.

Saint Francis administrators said development of their health plans began several years ago, but the absence of a contract with United contributed to their decision to announce the Saint Francis health insurance products before the 2021 plan renewal deadlines this fall.

“For us, being out of network with United and not being able to connect with those companies that use United made it imperative we start this immediately,” said James Burke, Saint Francis chief administrative officer and general counsel.

“I don’t think this is turning our back on United,” he said. “We want to be back in network with United. We want to stay in network so employers have choices. We’re still at the table (and) have been all along. We’ve never walked away from discussions (with United).”

What it comes down to, Burke said, is giving employers and employees more choices.

“We think it’s better to let the patient choose where they want to go, and if the patient doesn’t want to choose us, then we’re doing something wrong,” he said.

More information about the Saint Francis health insurance program is available online at www.saintfrancishealthplans.com.

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